Medical Assistants and Medication Errors

We want to remind all practicing medical assistants that medication errors refer to errors in the processes of ordering, transcribing, dispensing, administering, or monitoring medications, irrespective of the outcome (i.e., injury to the patient). 


One example is an order written for amoxicillin without a route of administration. Other medication errors have a greater potential for patient harm and so are often designated as "serious medication errors" or "potential ADEs"—e.g., an order for amoxicillin in a patient with past anaphylaxis to penicillin.


We also want to remind medical assistants who call in prescription orders to a pharmacy, or approve prescription refills for a patient to do this ONLY upon approval from the doctor. Only call in orders that are logged in the patient's medical chart. Any prescriptions or refill orders completed and called in to the pharmacy should then also be annotated, dated and initialed by the medical assistant who made the call (you!).

Always legibly identify yourself by signature, or initials

All entries in the medical record must be signed by the author. Federal law mandates that only the author can sign his/her entries in medical records.

Abbreviation to Avoid	Intended Meaning	Misinterpretation	Correction
D/C	discharge discontinue	Premature discontinuation of medication (intended to mean discharge) especially when followed by a list of discharge medications.	Use "discharge" and "discontinue"
MgSO4	Magnesium sulfate	Morphine sulfate
MSO4	Morphine sulfate	Magnesium sulfate
MTX	Methotrexate	Mitoxantrone
ZnSO4	Zinc sulfate	Morphine sulfate
q.d. or QD	every day	Mistaken as q.i.d. especially if the period after the "q" or the tail of the "q" is misunderstood as an "I".	Use "daily" or "every day" If abbreviation is used, capitalize and avoid use of periods.
q.o.d. or QOD	every other day	Misinterpreted as "qd"(daily) or "qid" (four times daily) if the "o" is poorly written	Use "every other day". If abbreviation is used, capitalize and avoid use of periods.
U or u	units	Read as zero (0) or a four (4) causing a 10-fold overdose or greater (4U seen as "40" or 4u seen as "44").	Unit has no acceptable abbreviations. Use "unit".
IU	international units	Misread as IV (intravenous)	Use "units"
TIW	three times a week	Mistaken as "three times a day"	Spell out "three times a week"

Proper Supervision of Medical Assistants: Doctors Take Massive Risks

Little oversights, simple miscommunication, unintended slip-ups, distractions and kind favors can lead to serious consequences and repercussions for each individual medical assistant, the doctor under whom they work, the patient and everybody else involved.

Medical Assistant Charged with 10 Felonies and Unlawful Practice

A medical assistant was arrested in 2009 in Las Vegas, Nevada for administering Botox treatments in her role while under the direction of a doctor. She was under the impression that she was simply doing what all medical assistants do and it never crossed her mind that she may be practicing outside her scope of practice as legislated by the Nevada State Board of Medical Examiners. Nevada law prohibits medical assistants from administering any kind of medications, this includes giving injections. While the restriction had largely gone unenforced it wasn't until this medical assistant's arrest on 10 felony counts on allegations of "unlawful practice of medicine" received media attention. The unsuspecting medical assistant's whole world came to a crashing halt when she was charged.

UPDATE:
Betty Guerra’s nightmare is over. On October 14th the Las Vegas Review Journal reported that the 45-year-old former medical assistant learned from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed. The State Medical board reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox as long as they are under the “direct supervision” of a physician; meaning the doctor is on the premises.

Doctors Taking Massive Risks

Another medical assistant was fired in 2011 in Fort Collins, Colorado after inadvertently putting young children in harms way. She only administered half the amount of a pre-measured children's influenza vaccine to children in the pediatrics office. Assuming it was an adult dosage in the vial, she simply withdrew half the amount of the vial into the syringe and administered it, hence each child recieved only half the required dosage. In addition, after drawing up the vaccine from the vial the assistant removed the needle from the syringe and replaced it with a sterile needle, but not a new syringe, potentially exposing each child to bloodborne pathogenes and serious infections by reusing the syringe.

Safety Guidelines in the Administration of Medications

Medical assistants must never be tempted to do, or say, more than they should and never attempt procedures that they weren't adequately trained and properly supervised to do. They should administer only those medications for which the physician has written and signed the order and must always check with the ordering doctor when in doubt about any medication dosage. When dispensing medications, they must carefully check to make sure that everything on the medication order corresponds exactly with the label on the package or container and medications that are not clearly labeled should never be used, or put back into the medicine closet.

You might ask: "What are the 5 Rs?"

To learn more about the medical assisting career please visit Medical Assistant NET on the Web. 

Proper Utilization and Supervision of Medical Assistants

Medical Assistant Supervision | Proper Utilization and Evaluation of Skills

United States laws restrict who can give medical and health advice, or apply certain medical treatments and modalities to patients, making the unauthorized practice of medicine a serious crime. Physicians and non-physician practitioners (physician assistants, or nurse practitioners) are in charge and responsible for the care of their patients and must keep a watchful eye over those to whom they delegate tasks.

Practicing Medicine Without a License

Between 2000 and 2007 the state Board of Medicine and State Board of Osteopathic Medicine in Pennsylvania has fined 57 people for unlicensed practice of medicine, among them numerours medical assistants. One of the more infamous cases involved a Pennsylvania certified medical assistant, who, acting on a doctor's orders, administered an experimental intravenous drug treatment that killed a 5-year-old boy in 2005. The doctor who authorized the unapproved treatment for autism spectrum disorder faces civil and criminal charges including manslaughter. The medical assistant, who reportedly never administered an IV-push before, has not been charged.

Proper Utilization of Medical Assistants in the Medical Office

Procedures that may lead to medical acts of negligence and scope of practice violations must be recognized so that they can be prevented. Such may include assigning procedures to medical assistants that cannot be delegated under the state's medical practice law, or performing procedures that carry a higher risk of injury, such as injections, venipunctures, radigraphic imaging, ultrasound, and other procedures where a medical assistant must first have been properly trained, instructed, taught and supervised.

Read a summary of the Medical Assistant's Scope of Practice here. To learn more about the medical assisting career please visit Medical Assistant NET on the Web.

Medical Assistant Charged with Felonies and Unlawful Practice of Medicine

An Unsuspecting Medical Assistant Was Charged with 10 Felonies and Unlawful Practice of Medicine in Nevada for Administering Botox Injection Under the Supervision of a Physician.

Nevada law prohibits medical assistants from administering any kind of medications, this includes injections. While the restriction had largely gone unenforced it wasn't until a medical assistant's arrest on 10 felony counts on allegations of "unlawful practice of medicine" received media attention.

The medical assistant was arrested in 2009 in Las Vegas for administering Botox treatments in her role as a medical assistant while under the direction of a doctor. She was under the impression that she was simply doing what all medical assistants do, and it never crossed her mind that she may be practicing outside her scope of practice as legislated by the Nevada State Board of Medical Examiners. Her whole world came to a crashing halt when she was charged with 10 felony counts on allegations of "unlawful practice of medicine".

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It is a massive risk that some medical assistants take, especially when they are trained on the job without access to current information from a professional membership organization, such as the American Association of Medical Assistants, American Medical Technologists, or National Healthcareer Association; and not having received formal training from an accredited vocational training institution where expertly trained faculty instruct future medical assistants on what they can and cannot do. This leaves them open to the assumption that as long as they work under the umbrella of the doctor who taught them what to do they are allowed to do what is asked. However, this is a  misconception.

The rule is that ALL medical assistants, regardless of the amount of education, training and experience must realize that they are subject to certain laws and limitations and can practice only within their specific scope of practice. For example, certain US states require medical assistants to have a special license from their state to expose patients to X-rays. Other states mandate special training before a medical assistant can administer certain types of needle injections, vaccinations, and screening tests such as for allergy testing, or PPD/Mantoux skin tests.

The Nevada Sate Board of Medical Examiners, in an emergency meeting on Sept. 18, 2009 adopted a regulation to stop medical assistants from performing certain services, such as administering the cosmetic drug Botox. But the regulation allowed medical assistants to give flu shots and vaccinations.

Medical Assistants Who Administer Medications

The confusion about what a medical assistant can and cannot do continues, mostly because of the wide variety of training options, differences in programs, and lack of clearly spelled out rules and regulations. Medical assistants are unlicensed health professionals with special training, which means they have the duty to abide by the rules and use ordinary care within their scope of practice. Often, the doctors and supervising nurses in the medical office wonder: "Can I delegate this, or that task to my medical assistant?". This includes the question, whether the medical assistant is allowed to administer medications.

Medical assistants are allowed to administer medications, or hand patients a measured dose for self-administration while under observation IF it has been so ordered by their medical doctor*, or licensed health care professional (*by doctor's, or licensed provider's orders, such as a physician's assistant, or an advance practice registered nurse ONLY).

Medical assistants can administer only oral, topical, or inhalant medications, suppositories, intradermal, subcutaneous, or intramuscular injections, and medications applied to mucous membranes , such as eyes, nose, mouth, and ears.

Administration means the direct application of a medication by inhalation, ingestion, or any other means to the body of a person, including by injection.

To learn more about educational requirements, and practical tips for handling emergencies, and proper documentation visit Medical Assistant Net on the Web. There is lots of additional "scope of practice for medical assistants" info at that web site.

Medical Assistant's Scope of Practice

I am sure everybody who reads this can relate to the concerns and questions medical assistants have, and the confusion that revolves around the medical assistant's scope of practice.

Not only are medical assistants confused, so are their employers, managers, and supervisors. They, too are not always 100% sure about what tasks can be assigned to the medical assistant without asking them to go beyond and above their scope of practice. Post after post in our medical assistant web forum proves this.


What's The Problem?
Medical assistants who don't know or disregard established professional standards and attempt to perform procedures or tasks beyond their training, capabilities, or scope of practice are in danger of exposing themselves, supervisors, and the medical office all together to serious consequences and possible liability issues.

What's the Consequence?
This is where most medical office supervisors immediately resort to drastic measures. The medical assistant is immediately suspended and dismissed without any further counseling or second chances. The fear of damaging their doctor's or medical office's reputation and the consequences of a malpractice law suit is overwhelming. Where so much is at stake, there just rarely are second chances given, especially when it comes to new staff members where trust has not yet been established.


Whose Responsibility Is It?
It must be said that when transgressions and disregards of what a medical assistant can and cannot do happen, it is not always the medical assistant's fault alone. EVERYBODY in the medical office must be sure they know their state's rules and regulations regarding the medical assistant's scope of practice. It is a shared responsibility shared among many that starts with the medical assistant's instructors, supervising physicians and health care practitioners, and office managers to know, and clearly delineate and communicate the medical assistant's role and responsibilities. And the buck does not stop there! Every working medical assistant must make it their own responsibility to know what the the rules are in their state.

Examples
For example, medical assistants are not allowed to make independent medical assessments (triage) or give medical advice at any time under any circumstances. Also many states mandate that anybody performing phlebotomy, ultrasound procedures, EKGs, or X-rays must have a specific licence to do so.

Medical assistants who draw blood in California and those who perform point of care testing in Georgia are also required to be certified. The latest issue and debates revolve around medical assistants starting and disconnecting IV lines or administering phototherapy in an UV booth to patients. Recently an unsuspecting medical assistant was reprimanded and suspended on the spot because of this confusion.

Last But Not Least a Tip:
Every working medical assistant and staff member in the medical office who is providing direct and indirect patient cares should make sure they have adequate malpractice and professional liability insurance coverage, because each one is responsible for his/her own negligent acts, since malpractice is defined as "the negligent act of a person with specialized training and education."

To learn more about educational requirements, and practical tips for handling emergencies, and proper documentation visit Medical Assistant Net on the Web. There is lots of additional "scope of practice for medical assistants" info at that web site.